Breast Milk
Benefits & Barriers
Dr Sheela Bano
Obstetrician
Aga Khan Medical Center, Gilgit
Composition of Breast Milk
• Colostrum: small amount during days 3 to 5
– High in protein, immunoglobulins and minerals,
– Low in lactose and fat
• Transitional milk: produced during days 6 to10
– High in fat, lactose
– Lower in protein and minerals
• Mature milk: available by 2 weeks post-partum
– Average secretion: 750 ml/d
– Provides 20-22 kcal/ounce
– 60-80% whey protein, 40% lactose, 50% fat
– Growth factor
– Low in vitamin D
Colostrum
• The first milk, colostrum, is rich in protein and
antibodies
– Nuetrophils in colostrum promote bacterial killing,
phagocytosis, and chemotaxis
• Small volume is normal:
– 7-123 ml/day first day
– 2-10 ml/feeding day 1
– 5-15 ml/feeding day 2
Nutritional Requirements
During Lactation
• Breastfeeding is an anabolic state, resulting in increased energy and nutrient
needs:
– 500 kcal/day (birth to 6 mo)
– 400 kcal/day (7 - 9 mo)
• Protein, zinc, niacin, vitamins A, E, C requirements increase above those in
pregnancy.
– Protein = 71 g/day
• Chronically low maternal iron, vitamin B, C, D, thiamin, and folate intake leads
to low content in breast milk.
Benefits of breastfeeding for the infant
• Provides superior nutrition for
optimum growth.
• Provides adequate water for
hydration.
• Protects against infection and
allergies.
• Promotes bonding and
development.
Transparency 2.5
Summary of differences between milks
Human milk Animal milks Infant formula
correct amount, easy too much, difficult to
Protein partly corrected
to digest digest
enough essential fatty lacks essential fatty
Fat no lipase
acids, lipase to digest acids, no lipase
Water enough extra needed may need extra
Anti-infective
present absent absent
properties
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health
Organization, 1993 (WHO/CDR/93.6).
Transparency 2.6
When Women Don’t Breastfeed...
• They recover more slowly after birth
• Have Increased risk of:
Breast Cancer Ovarian Cancer
Endometrial Cancer Cardiovascular Disease
Osteoporosis Type 2 Diabetes
High Blood Pressure Metabolic Syndrome
Anemia Postpartum Depression
• The longer a woman breastfeeds, the more
her risk of breast cancer goes down
7
Benefits of breastfeeding for the mother
• Protects mother’s health
– helps reduces risk of uterine bleeding and
helps the uterus to return to its previous size
– reduces risk of breast and
ovarian cancer
• Helps delay a new pregnancy
• Helps a mother return to pre-pregnancy weight
Transparency 2.8
Risks of artificial feeding
Interferes with bonding
More allergy and
More diarrhoea and milk intolerance
respiratory infections
Increased risk of
Persistent diarrhoea some
Malnutrition chronic diseases
Vitamin A deficiency Overweight
More likely to die Lower scores on
Mother intelligence tests
May become Increased risk of anaemia,
pregnant sooner ovarian and breast cancer
Adapted from: Breastfeeding counselling: A training course. Geneva,
World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.9
Benefits of breastfeeding for the family
• Better health, nutrition, and well-being
• Economic benefits
– breastfeeding costs less than artificial
feeding
– breastfeeding results in lower medical care
costs
Transparency 2.10
• The most common reason given by mothers for early
discontinuation of breastfeeding is the “perception that
their milk is insufficient to satisfy their infant’s needs” a
phenomenon now termed the “INSUFFICENT MILK
SYNDROME” or IMS.
• The insufficient milk syndrome can only be understood
in the context of fundamental changes in the
breastfeeding process undergone by women who live in
industrialized societies.
Management
• Optimize positioning and latch
• Treat sore nipples
• Increase frequency of feeds
• Express/pump milk after feedings to ensure
complete emptying of breasts
• Treat maternal or infant illness if present
Management
• If clinically indicated, supplementation may be
necessary
• Supplement with expressed breast milk if
possible
• Begin with only 1-2 oz after each feeding until
milk production increases
Treatment of Sore Nipples
• Ensure infant is well-positioned and latching
on correctly — this may be all that is needed
• Apply breast milk to nipple and areola after
feeding, allow to air dry, then apply medical-
grade lanolin
• Use only water to clean breasts
• May use acetaminophen or ibuprofen for pain
management
Insufficient Lactation
Infant Failure-to-Thrive
• Maternal causes
– Poor milk production: diet, illness, fatigue
– Poor let down: psychological, drugs, smoking
– Inverted nipples
• Infant problems
– Poor intake: poor suck, infrequent feedings, Cleft palate
– Low intake: vomiting, diarrhea, malabsorption
– High energy needs: CNS impairment, premie, SGA, CHD
How do I know if the infant is
breastfeeding effectively?
• Baby is content after feedings
• Audible swallowing during feedings
• Mother’s nipples are not sore
• 3+ stools/day after day 1
• No weight loss after day 3
• Breast feels less full after feeding
How do I know when the milk has
“come in”?
• 6+ wet diapers/day
• Yellow, seedy stools by day 4–5
• Breasts are noticeably larger and feel firmer
and heavier
• Mother may begin to feel “let-down” reflex
• Breasts may leak between or during feedings
Management
• REASSURANCE
• AWARENESS
• COMPLETE PHYSICAL EXAMINATION
• OBSERVATION OF THE FEEDING
• TREAT THE CAUSE IF ANY
Reassurance
• If the infant is gaining weight well and stooling
and voiding appropriately
– Reassure mother her milk supply is adequate
– Discourage supplementation
– Review normal patterns of breastfeeding,
elimination, and weight gain
• Complete physical exam including:
– Mother’s breasts and nipples
– Infant oral-motor exam
– Evidence of congenital anomalies
– Evaluation of frenulum
• Observation of a feeding to look at:
– Infant positioning
– Latch
– Infant suck
Management
• Optimize positioning and latch
• Treat sore nipples
• Increase frequency of feeds
• Express/pump milk after feedings to ensure
complete emptying of breasts
• Treat maternal or infant illness if present
GALACTOGOUS FOOD
• Water
• Oat meal
• Garlic addition in food
• Carrots
• Fennel
• Nuts
• Papaya green
• Sesame
• Ginger in meals
•
